Health Committee on Feb. 28th, 2022

[The Chair (Mr. Sean Casey (Charlottetown, Lib.)), Conservative, Laila Goodridge]

I call the meeting to order.

Welcome to meeting number nine of the House of Commons Standing Committee on Health. Today, we're meeting for two hours to hear from witnesses for our study of the emergency situation facing Canadians in light of the COVID-19 pandemic.

Before I introduce today’s witnesses, there are a few regular reminders for hybrid meetings.

Today’s meeting will be taking place in a hybrid format, pursuant to the House order of November 25, 2021. Members are attending in person in the room and remotely, using the Zoom application. I think all the members are or will soon be in the room, and the only people on Zoom are the witnesses. I would like to take this opportunity to remind the people who are on Zoom that the taking of screenshots or photos of your screen is not permitted.

The proceedings will be made available on the House of Commons website.

All health protocols prescribed by the public health authorities and the directive of the Board of Internal Economy of October 19, 2021, will be observed and respected.

Before we get to our witnesses today, I'm informed that we have a couple of new members in the room. I would like to welcome Mr. Barrett, who replaces Mr. Berthold, and Ms. Goodridge, who replaces Ms. Kramp-Neuman. I appreciate the time and the work that the outgoing members have contributed to the committee, and I have every confidence that those shoes will be amply filled by their replacements.

However, Mr. Berthold's departure means that we are left with a vacancy in the first vice-chair role. Pursuant to Standing Order 106(2), the first vice-chair must be a member of the official opposition. I am now prepared to receive motions for the first vice-chair.

Go ahead, Mr. Lake.

[Mike Lake, Conservative, Edmonton—Wetaskiwin, AB]

I nominate Michael Barrett.

[The Chair, Liberal, Sean Casey]

It's been moved by Mr. Lake that Michael Barrett be elected as the first vice-chair of the committee. Are there any further motions?

Seeing none, is it the pleasure of the committee to adopt the motion?

(Motion agreed to)

I declare Mr. Barrett duly elected first vice-chair of the committee. Congratulations, sir.

Now we'll move on to our witness and their opening remarks. To begin, both the Office of the Auditor General and the Public Health Agency of Canada have five minutes to make their opening statement before rounds of questions, which will occupy the remainder of our two hours.

With us today, we have from the Office of the Auditor General, Andrew Hayes, deputy Auditor General, and Jean Goulet, Carol McCalla and Chantal Richard, principals. From the Public Health Agency of Canada, we Brigitte Diogo, vice-president of the health security and regional operations branch; Cindy Evans, vice-president of the emergency management branch; and Christopher Allison, acting vice-president of corporate data and surveillance branch.

Thank you all for being with us here today. We're going to proceed in the order listed on the notice of meeting.

We're going to ask Deputy Auditor General Hayes to kick us off. You have the floor for five minutes.

[Andrew Hayes, Deputy Auditor General, Office of the Auditor General]

Mr. Chair, thank you for this opportunity to discuss our reports on the Public Health Agency of Canada’s response to the COVID-19 pandemic. First, I would like to acknowledge that this hearing is taking place on the traditional unceded territory of the Algonquin Anishinabe people.

Joining me today are Chantal Richard, Carol McCalla and Jean Goulet, who were the principals responsible for the three audits I will be discussing.

If I had to sum up our audits of pandemic preparedness, surveillance and response, I would say that, on the whole, the Public Health Agency of Canada was not as well prepared as it should have been to deal with this crisis. However, as we saw across the organizations tasked with pandemic response that we have audited to date, public servants rallied and adjusted their activities in real time.

In our March 2021 report that looked at the preparedness side, we found that not all emergency and response plans were up to date and tested at the onset of the pandemic. Data sharing agreements with the provinces and territories were also not finalized.

In addition, the agency relied on a risk assessment tool that was untested and not designed to consider pandemic risk. As a result, despite growing numbers of COVID-19 cases in Canada and worldwide, the agency continued to assess the pandemic risk as low. The global public health intelligence network did not issue an alert about the virus that would become known to cause COVID-19.

Once the pandemic hit Canada, the Public Health Agency of Canada and the Canada Border Services Agency worked together to implement border restrictions and quarantine requirements. However, we found that the Public Health Agency was unprepared for a nationwide quarantine. For example, it struggled with a paper system to gather travellers' information. This hindered efforts to follow up with individuals at risk of not complying with quarantine orders. As a result, the agency did not know whether 66% of incoming travellers who were required to quarantine in fact did so.

Our December 2021 report showed an improvement in the administration of the 14-day quarantine orders since our initial audit, partly because the agency had moved to an electronic system to collect travellers' information. However, between January and June 2021, the agency was still unable to confirm whether 37% of inbound travellers complied with quarantine orders. That is still a large number of people to lose sight of.

This second audit also looked at the enforcement of new testing orders. We found that the agency was either missing or unable to match 30% of COVID‑19 test results to travellers arriving in Canada. In addition, the agency lacked records for 75% of travellers arriving by plane, making it impossible to know whether these travellers quarantined at authorized hotels as ordered.

Our audit of personal protective equipment and medical devices released in May 2021 also showed that the Public Health Agency of Canada was not as prepared as it should have been to deal with the surge in requests for equipment from the provinces and territories triggered by the pandemic. This was because the agency had not addressed long-standing issues affecting the management of the National Emergency Strategic Stockpile, though these had been raised in audits and reviews going back more than a decade.

Despite these pre-existing issues, the agency worked with Public Services and Procurement Canada and Health Canada and adapted its activities to help meet needs for personal protective equipment and medical devices across the country. For example, the agency shifted to a bulk purchasing strategy and improved how it assessed needs and allocated equipment, among other changes.

If there is one overall takeaway from these audits, it is that long-standing known issues, such as outdated systems and practices, must be dealt with. This would allow government organizations to be better prepared for unforeseen events such as this pandemic.

This concludes my opening remarks. We would be pleased to answer any questions the committee may have.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you very much, Mr. Hayes.

Now, on behalf of the Public Health Agency of Canada, we're going to hear from Ms. Diogo. Welcome to the committee. You have five minutes.

[Brigitte Diogo, Vice-President, Health Security and Regional Operations Branch, Public Health Agency of Canada]

Thank you, Mr. Chair.

My name is Brigitte Diogo and, as you mentioned, I'm the vice-president for the health security and regional operations branch. I am happy to be here today to have the opportunity to speak to the committee. I am joined by my two colleagues Cindy Evans, vice-president of the emergency management branch and Chris Allison, acting vice-president of the corporate data and surveillance branch.

As the pandemic approaches the two-year mark, we recognize the resilience of Canadians and the sacrifices everyone had to make in these unprecedented times to minimize the impacts of COVID-19. We are proud to say that the agency has worked throughout the pandemic to take the actions needed to protect the health and safety of Canadians.

The pandemic is not over and the agency must remain nimble and ready to respond to new risks in an appropriate and proportionate manner.

I would like to take a few minutes to talk about the Public Health Agency of Canada's efforts since the onset of the pandemic, in close collaboration with federal, provincial and territorial partners, as well as learning from the experiences of our international counterparts.

Over the past 24 months, the Public Health Agency of Canada has been on the front lines of the federal response to COVID-19. The agency has taken an evidence-based, multi-layered approach to public health measures, which have been adapted as we learned more about the virus and the delta and omicron variants that have emerged.

A year ago at this time, we were in the early stages of getting vaccines into the arms of Canadians. Thanks to a solid immunization strategy and federal, provincial and territorial governments working together, as of February 25, more than 80% of the total population is fully vaccinated. That is one of the highest rates in the world. Additionally, more than 55% of the population over 18 years of age have received an additional dose, and clinics are continuing to offer boosters.

With unvaccinated individuals who get COVID‑19 being 4 times more likely to be hospitalized than fully vaccinated individuals, it is clear that the vaccine roll-out helped to reduce severe illness and save lives.

Throughout the pandemic response, the Government of Canada has adjusted its border measures as new data, and scientific evidence became available, and in response to the epidemiological situation both in Canada and internationally.

The Government of Canada recognizes that border measures can pose challenges for individuals and families, but these measures help to prevent new chains of transmission in Canadian communities and protect Canada’s health care capacity and vulnerable populations. As the Auditor General noted, the agency was able to successfully adapt to secure personal protective equipment and medical supplies.

Throughout the pandemic, science and collaboration have been fundamental keys to inform the agency's efforts. We have gained much scientific knowledge about this novel virus and its variants to inform our advice and actions, and we have worked closely with other federal agencies, provinces and territories, Indigenous partners and academic and international counterparts on various, innovative research initiatives.

For example, the agency collaborated with other levels of government such as municipal governments, as well as academia, to establish a pan-Canadian network for wastewater surveillance to monitor for early-warning signals of COVID‑19 and its variants across the country.

In conclusion, collaboration, leadership, communication, science, surveillance and vaccination have been critical as we manage the pandemic. These same factors will continue to be key as we move forward. While significant strides were made over the course of the pandemic, the agency acknowledges that it was not as prepared as it could have been prior to the pandemic and that there are lessons to be learned.

We remain committed to responding to the Auditor General's recommendation in full within the established timelines. As the omicron wave continues to recede, we need to recognize that COVID-19 will be with us for the foreseeable future.

The Public Health Agency of Canada will continue to incorporate the knowledge and expertise it had gained towards our effort for the long-term sustainable management of COVID-19, and to better prepare for any future public health crisis.

My colleague and I will be happy to take your questions.

Thank you.

[The Chair, Liberal, Sean Casey]

Thank you very much, Ms. Diogo.

We're now going to begin with rounds of questions, starting with the Conservatives.

Dr. Ellis, please, you have six minutes.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you, Mr. Chair.

Thank you to the witnesses for their opening statements and for appearing here today.

This is for Mr. Hayes on the Auditor General side. On the global public health intelligence network, you stated that there was no alert back in 2020. Sir, could you please tell us the budget for the global public health intelligence network?

[Andrew Hayes]

That may be a question best directed to the Public Health Agency. I don't have numbers about their budget for the global public health intelligence network.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Does anybody on the PHAC side know the answer to that?

[Cindy Evans, Vice-President, Emergency Management Branch, Public Health Agency of Canada]

Mr. Chair, we'd be pleased to come back to the committee with that specific number. I don't have that number on hand in front of me.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Okay, so nobody knows the budget.

For the same outfit, as we talked about, there was no alert. Can you name three changes, sir, that happened over the last two years to the intelligence network to make it better?

[Andrew Hayes]

Again, I would ask the Public Health Agency if they might have an answer to that. In our audit, we noted the weaknesses in not providing an alert and identified that, over the course of the last few years, the process has changed for the approval of alerts, and there have been considerably fewer since the process changed.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Can anybody name three changes that have been made?

[Laila Goodridge]

Thank you, Mr. Chair.

With respect to the global public health intelligence network, we thank the Auditor General for her attention to this important function.

A number of changes have taken place since the audit and since the independent expert panel. We've developed an action plan to address all of the recommendations. We have improved and streamlined the decision-making process for issuing GPHIN alerts and other GPHIN products and processes.

With respect to the technology, we have migrated the GPHIN system to a new cloud function, as well having moved forward to hire a technical adviser and investing in the training and development.

Those are a number of the changes that have been initiated since the time of the audit.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Thank you.

Apparently, if I understood Mr. Hayes correctly, 75% of information for travellers coming into this country was not available. Can anybody tell me why we continue with border measures with such a leaky border?

[Brigitte Diogo]

Mr. Chair, again, I would like to take the opportunity to thank the Auditor General for the report.

We have made several improvements to the way we collect data. In particular—I think it was in the first report of the Auditor General—we have moved from a paper system to electronic collection of information and are able to share information with the provinces and territories much faster. We have also made some changes internally to improve our compliance and enforcement approach.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

To continue on with that, if I'm correct, it's interesting that rapid antigen tests in asymptomatic individuals have a sensitivity rate of about 44%. Plus, we're only capturing about 25% of the data in travellers. Can anybody tell me why we continue to use a system like that, which penalizes Canadians?

[Brigitte Diogo]

Mr. Chair, until recently, the only requirement that we had for people arriving from abroad was to use the molecular test. The change to allow for antigen tests starts today.

With regard to the domestic testing, whether testing on arrival or testing on day eight, this is based on a molecular test and the PCR technology that we have been using.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

Mr. Chair, that's fine. I thank you for answering.

I guess my point is that we're moving to an antigen test that is 44% sensitive in a system that's only collecting 25% of the data. Why would we do that? What's the benefit to our border security? To me, the math doesn't add up. That means 56% of asymptomatic people coming into the country could be told that they have a false negative test, and we're only collecting 25% of the data. Mathematically that makes no sense to me.

[Brigitte Diogo]

The change has been made in recognition of the high vaccination rates that have been achieved. Recognizing that this is a change that we just implemented today, the agency will continue to monitor the results and determine whether other changes will need to be made to the regime.

Thank you.

[Stephen Ellis, Conservative, Cumberland—Colchester, NS]

I thank you for that.

Mr. Chair, I guess I want to ask again why we made a change to the rapid antigen test that we know is not sensitive in asymptomatic individuals, because, if you're symptomatic, guess what? You're not getting on an airplane. The question remains as to why we would recommend this change. Why would we keep it at all? That doesn't make any sense to me. I guess this is the third time I'm asking the same question, so why? I really would like an answer.

[Brigitte Diogo]

While the antigen test, Mr. Chair, is not as sensitive as the PCR test, it is still a test that has seen a lot of improvement over time, and the department feels that, based on what we have learned from antigen tests, this is an option that we would like to offer to Canadians who are travelling and returning from travel abroad. In particular, when people arrive in Canada, they will still be subject to mandatory testing. The Public Health Agency will continue to collect data to determine whether adjustments will need to be made to that regime.

[The Chair, Liberal, Sean Casey]

Thank you, Ms. Diogo.

Thank you, Dr. Ellis.

Next we'll have Mr. van Koeverden, please, for six minutes.

[Adam van Koeverden, Liberal, Milton, ON]

Thank you, Mr. Chair.

Thank you so much to all of the witnesses for joining us here today.

I'd also like to welcome our two new members, MPs Goodridge and Barrett. Welcome to HESA. I thank you for being here today.

I also want to thank you for all of your extraordinary work over the last two years. These last two years have been relentless, and all of our staff have been exhausted by them, and I imagine that you and your staff have been too, so I just want to acknowledge how challenging they've been and thank you for your extraordinary efforts.

I have two questions today, and both will focus on the Public Health Agency of Canada. Canada is fortunate to have one of the lowest death rates of all of our peer nation countries. While it's less productive to focus on how our system proved to be resilient and supported the health and safety of Canadians, I'm wondering why, from your perspectives, given that we have seen this pandemic unveil quite a few gaps in our health care system and some issues that we need to address as soon as possible....

It's also true that, from a performance perspective, Canada has demonstrated fairly good resilience against COVID-19. I suppose we all have our reasons to believe that to be the case, but I would like to hear from the Public Health Agency of Canada on why they believe our country has fortunately been among the countries with a lower death rate than many others.